Abstract: Objective To explore the correlation between clinical features, survival and circulating tumor cells(CTC) in advanced colon cancer. Methods The Cell SearchTM system was used to detect the expression of CTC from 36 patients with stage Ⅲ colorectal cancer after surgery and 45 patients with stage Ⅳ colorectal cancer before chemotherapy in our department from January 2017 to July 2018. The relationship of CTC expression with tumor staging, tumor location, KRAS mutation status, liver metastasis, number of metastatic organs, tumor markers, and progression-free survival were analyzed. Results The positive rate of CTC was 13.9% in stage Ⅲ and 44.4% in stage Ⅳ with statistically significant difference(P=0.003); 51.9% in KRAS mutation versus 21.2% in wide type(P=0.013); 51.5% in patients with liver metastasis versus 16.7% in patients without metastasis(P=0.001); 21.3% in patients with less than 2 metastatic organs and 44.1% in patients with more than 2 metastatic organs(P=0.028). The CTC positive rate in patients with higher level of tumor markers such as CEA, CA199, serum ferritin(SF) were significantly higher than those in patients with the normal level(CEA, 45.2% vs 15.4%, P=0.004; CA199, 57.1% vs 27.1%, P=0.002; SF, 51.7% vs 19.2%, P=0.002). Forty-five patients in stage Ⅳ were followed up The PFS of CTC negative group was slightly higher than that of CTC positive group, without statistically significant difference(8.1 months vs 6.2 months, P=0.834). Conclusion Circulating tumor cells are associated with tumor burden and tumor biomarker, which can be used to assess the biological behavior and prognosis in patients with intermediate and advanced colorectal cancer.